For: Co-signer (indemnitor)

U.S. Fire Indemnitor Application and Agreement (Form #2)

Part two: references, financial statement and the indemnity agreement you sign.

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Part 1 of 4

References and Financial Statement

THIS INDEMNITY AGREEMENT (“Agreement”) is entered into between you, the undersigned Indemnitor, and Surety through Surety’s duly-appointed independent bail producer referenced below (“Producer”).

FORM #2

6.) REFERENCES

Name 1:

Relation:

Address:

Employer:

Home Phone #:

Work Phone #: (optional)

Cell Phone #: (optional)

Name 2: (optional)

Relation:

Address:

Employer:

Home Phone #:

Work Phone #: (optional)

Cell Phone #:

Name 3: (optional)

Relation:

Address:

Employer:

Home Phone #:

Work Phone #: (optional)

Cell Phone #:

7.) FINANCIAL STATEMENT/CREDIT INFORMATION

Cash on Hand: $

Cash in Bank: $

Real Estate Value: $

Real Estate Mortgage: $ (optional)

In whose name is title?

Monthly salary or wages: $